Magstim Brochure

The Leading Provider of Advanced Neurostimulation Products

Advanced Neurostimulation The Magstim range of magnetic stimulation systems provide a variety of high quality solutions for researchers and clinicians working within Neurology, Neuroscience, Psychiatry and Rehabilitation.

Magstim has substantial expertise in magnetic stimulation, and is a leader in the field, offering a wide range of magnetic stimulators and stimulating coils to suit a variety of clinical and research applications.

Non-invasive Neuromodulation Magnetic stimulation is a non-invasive and painless method of stimulating human tissue using strong, time varying magnetic fields to induce small currents in nerve tissue. These are able to stimulate the human cortex, spinal roots and peripheral nerves.

Depending on the application a variety of output waveforms may be used to excite or inhibit nerve response. These pulses can be either monophasic or biphasic, or a combination of the two.

This brochure is intended for users of TMS equipment outside of the USA.

“ a leader in the field Users of Magstim Transcranial Magnetic Stimulators in the USA please note: Caution - Investigational Device. Federal (or United States law) limits device to investigational use.

Magstim

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Monophasic single pulse systems are favoured in neurological applications due to the accuracy of the stimulation and the low heat output. For repetitive stimulation that is used in neuroscience and psychiatry, biphasic systems are the preferred option due to their ability to produce short and efficient pulses at high frequency.

Magstim stimulators can be used in combination with equipment such as: i ● fMRI ● EMG ii ● EEG iii iv ● Image-guided TMS ● tDCS / tACS Magstim 200²

Magstim BiStim²

Magstim Rapid²

Magstim Rapid² Plus¹

Monophasic

Monophasic Twin Pulse

Biphasic

Biphasic

2.80kV

2.50kV*

1.67kV

1.67kV

2.0s 3.0s 4.0s

2.0s 3.0s 4.0s

Single PSU - 50Hz Dual PSU - 100Hz Single PSU - 30Hz Dual PSU - 50Hz Single PSU - 15Hz Dual PSU - 25Hz

100Hz 97Hz 41Hz

Minimum Inter Stimulus Interval

N/A

1.0ms

N/A

N/A

Minimum Inter Train Interval

N/A

4.0s

0.5s

0.5s

Output Type Maximum voltage Maximum repetition rates (230V configuration)

30% 50% 100%

* Also available as 2.80kV

“

of magnetic stimulation

Magstim

Magstim 2002 & BiStim2 - Monophasic Magstim produce two monophasic systems; the Magstim 200 and BiStim2, which are used extensively within the fields of neurology and neurophysiology. For accurate single pulse functionality, monophasic waveform systems are favoured for: ● ●

● ● ● ● ● ●

Neurological research Cortical mapping and brain research Functional assessment of central motor pathways Early diagnosis, assessment and monitoring of nervous diseases, such as Multiple Sclerosis and Motor Neurone Disease.

Single pulse Magstim 2002 provides users with the ability to elicit cortical evoked potentials, quickly and easily, as a routine component of clinical and research assessment techniques, including: ● ● ● ● ● ● ● ●

Triple Stimulation Techniquev Resting Motor Threshold Active Motor Threshold Central Conduction Time Motor Evoked Potential Input-Output Curve Cortical Silent Period Motor Mapping

2

Magstim 2002 offers complete flexibility and can be interfaced with a wide range of commercially available EMG systems.The monophasic waveform provides a high degree of hemispheric accuracy, low noise and less coil heating than other pulse ●waveforms.

2 ●The Magstim 200 is backward compatible with all Magstim ●stimulating coils, via the coil adaptor.

● Controlled Trains ● Magstim BiStim2 offers the potential to combine two Magstim ●2002 units to provide fully programmable paired pulse stimulation ●through a single stimulating coil.The ability to change pulse intervals and to independently control the power level of each Magstim 2002 allows for precise sub- and supra-threshold conditioning and test pulses.This is invaluable for the investigation of Inter-Cortical and Intra-Cortical Inhibition and Facilitation.

The inter-stimulus interval (ISI) of the two pulses is adjustable using either the integral stimulator controls, remote control coil or externally via triggering software offering complete user flexibility.

Two ISI options offer maximum controllability: ● ●

1ms - 999ms in 1ms resolution 1.0ms - 99.9ms in 0.1ms resolution

BiStim2 has the added advantages of being able to sum the two single pulses provided by the Magstim 2002 stimulators to produce a single high power pulse equal to 113% of a single Magstim 2002, as well as having the functionality to connect two individual coils for interhemispheric stimulation.

Magstim

Magstim Rapid2 - Biphasic

Magstim Rapid2 has an unique inbuilt two channel EMG amplifier with integral system acquisition software including latency and amplitude measurements. The dedicated touch screen user interface with internal and external memory makes storage and retrieval of results straightforward. Connecting the optional thermal printer allows for the provision of hardcopies.

Magstim Rapid repetitive Transcranial Magnetic Stimulation (rTMS) devices are highly effective non-invasive biphasic magnetic stimulators designed to meet the exacting needs of those involved â—? at all levels of clinical and academic research. Highly efficient, â—? short duration biphasic pulses makes it very well suited to bilateral cortical stimulation and is used in many different areas of research, including: 2

Rapid2 can be used with other investigation tools such as fMRI, EMG, EEG, tDCS, tACS and Image-guided TMS over a broad range of protocols and is fully compatible with existing Magstim coils through customised hardware.

Cognitive Neurosciencevi - in the investigation of learningvii viii, memoryix, speechx, hearing, visual, perception and functional connection

Magstim Rapid2 Plus1 is an innovative enhancement to the Rapid2 and is the only system able to offer a significantly higher repetition rate at stimulation output of 30% and higher.This is particularly useful in applications using protocols such as Theta Burstxii, as the Magstim Rapid2 Plus1 is capable of up to 89% output at 50Hz.

Psychiatryxi - to influence specific brain function within the dorsolateral prefrontal cortex Neurophysiology - used in the stimulation of the peripheral and central nerve pathways

With the addition of a Plus1 module a single PSU Rapid2 can be easily upgraded to dual PSU performance, whereas the addition of the Plus1 module to a dual PSU Rapid2 make high powered protocols feasible.

Rehabilitation - used in the promotion of muscle recovery and the relief of nerve spasticity

100

Rapid2 Plus1 90

Dual PSU Rapid2 80

Single PSU Rapid2 (230v configurations)

70

Frequency (Hz)

The Magstim Rapid2 range of repetitive stimulators has been developed to maintain a consistent pulse amplitude/frequency during the delivery of stimulation trains through Single Pulse, Repetitive, Burst and Session modes of operation. Rapid2 stimulators offer frequencies of up to 100Hz, with a 0.1Hz frequency resolution for the first 30Hz.

60 50 40 30 20 10 0 0

10

20

30

40

50

60

70

Power (%)

Magstim Rapid2 Performance

80

90

100

Magstim

Stimulating coils There is a wide range of stimulating coils available for use with Magstim systems, offering a great level of flexibility to both research and clinical users: Single, Double and Placebo coils are available in a variety of sizes for specific, targeted stimulation and research protocols.

It is now possible to achieve prolonged periods of stimulation ● the innovative Air Film Coil, created to work in combination with ● Magstim Rapid2 stimulators. with

●

The Air Film Coil uses innovative, ambient air flow and ● temperature regulated fan technology to enable the cooled coil to run indefinitely under certain protocols.

Key features of the Air Film Coil include: ● Delivers up to 3,000 pulses at 75% stimulator output at 10Hz stimulation (Biphasic waveform) over a 37.5 minute period and remains within allowed temperature limits (with a starting temperature of 22˚C). ● Extends the useful range of stimulating protocols available to researchers and clinicians ● Unlimited running time with certain protocols ● Quiet running

Single Coils 50mm Small Coil

Peripheral stimulation

● Facial nerve ● Superficial peripheral nerves

70mm Medium Coil

Peripheral stimulation or paediatric and infant TMS

● Peripheral nerves ● Cortical stimulation (paediatric)

Adult TMS

● Cortical stimulation (adult) ● Cervical nerve roots ● Lumbrosacral nerve roots

● 90mm High Power Coil ● ● ●90mm Remote Control Coil ● ●Double Coils ●Double 25mm B.I. Coil

Adult TMS - user interface on coil handle for easier control of stimulator

● Cortical stimulation (adult) ● Cervical nerve roots ● Lumbrosacral nerve roots

Accurate peripheral stimulation handle is perpendicular to coil head

● Facial nerve ● Superficial peripheral nerves ● Somatosensory evoked potentials

Double 40mm Coil

Accurate peripheral stimulation or accurate paediatric and infant TMS

● Peripheral nerves ● Cortical stimulation (paediatric)

Double 50mm Coil

Accurate adult TMS

● Cortical stimulation (adult) ● Peripheral nerves

D702 Coil (New design)

Accurate adult TMS

● Cortical stimulation (adult) ● Spinal roots ● Peripheral nerves

Double 70mm Remote Control Coil

Accurate adult TMS - user interface on coil handle for easier control of stimulator

● Cortical stimulation (adult) ● Spinal roots ● Peripheral nerves

Double 70mm B.I. Coil

Accurate adult TMS - handle is perpendicular to coil head

● Cortical stimulation (adult) ● Femoral nerve ● Back and neck

Double 110mm Cone Coil

Deep adult TMS - elicits responses from relaxed muscles of the lower pelvic floor and lower limbs

● Central motor disorders ● Spinal injuries ● Urology

Specialised Coils Double 70mm Air Film Coil

Built-in, active cooling for long stimulation protocols

Double 70mm Air Film Placebo Coil

Identical to the active coil (see above) other than the stimulating output.

Suitable for double-blind trials

Double 70mm Cooled Coil

Powerful active cooled coil with external air extraction unit

Double 70mm MR Compatible Coil Custom Coils

● ● ● ● ●

Psychiatry Cognitive neuroscience Neurology Neurophysiology Rehabilitation

● ● ● ● ●

Psychiatry Cognitive neuroscience Neurology Neurophysiology Rehabilitation

● Power intensive protocols ● Long duration protocols

Suitable for use in MRI scanners up to 3T ● Brain imaging research Coils of various configurations and dimensions can be designed for specific customer applications

● Specifications can be defined by the customer

Magstim

Go one step further with Magstim Innovations As well as the comprehensive range of standard products, Magstim provides a unique design service through the expertise of ● the “Magstim Innovations” team. Inspired by forward thinking researchers, the Magstim Innovations team is a dedicated group of● engineers who are able to develop to order the products required to meet the exact needs of the research community. Magstim Innovations helps push the boundaries of neuromodulation and brain stimulation to new levels.

the ‘7 Step’ Pathway

Customer enquiry & Specifications

Outline design proposal

Manufacturing

Based on 20 years experience, Magstim has developed a simple '7 Step' pathway to successful product production.This process ensures the product is delivered to the customer's exact requirements and needs, when it is needed.

Feasibility evaluation

Design Confirmation

Testing & installation

Agreement

The Magstim Company Ltd Spring Gardens, Whitland Carmarthenshire SA34 0HR Wales UK T: +44 (0)1994 240798 E: sales@magstim.com

www.magstim.com References i Combining TMS

and fMRI: From 'virtual lesions' to functional-network accounts of cognition.

Ruff CC, Driver J, Bestmann S. Cortex. 2008 Dec 6. [Epub ahead of print]

ii Combining TMS

and EEG to study cognitive function and cortico-cortico interactions.

Taylor PC, Walsh V, Eimer M. Behav Brain Res. 2008 Aug 22;191(2):141-7. Epub 2008 Apr 1. iii Mapping of the human visual cortex using image-guided transcranial magnetic stimulation.

Fernandez, E., Alfaro, A., Tormos, J.M., Climent, R., Martinez, M., Vilanova, H., Walsh, V., and Pascual-Leone, A. Brain Research Protocols 10:115-124, 2002. iv Complementary localization and lateralization of orienting and motor attention.

Rushworth, Matthew F.S., Ellison, Amanda, and Walsh, Vincent.

Nature Neuroscience, 4(6), June 2001. v Triple

stimulation technique (TST) in amyotrophic lateral sclerosis Leonid Komissarow, Jens D. Rollnik, Dessislava Bogdanova, Klaus Krampfl, F. A. Khabirov, Andon Kossev, Reinhard Dengler and Johannes Bufler Clinical Neurophysiology, Volume 115, Issue 2, Pages 356-360

vi Transcranial magnetic stimulation and cognitive neuroscience Vincent Walsh and Alan Cowey Nature Reviews – Neuroscience, Volume 1, October 2000, 73-79 vii The

Contribution of Primary Motor Cortex is Essential for Probabilistic Implicit Sequence Learning: Evidence from Theta Burst Magnetic Stimulation Leonora Wilkinson, James T. Teo, Ignacio Obeso, John C. Rothwell and Marjan Jahanshahi Journal of Cognitive Neuroscience

viii Transcranial

magnetic stimulation can measure and modulate learning and memory J Grafman E Wassermann Neuropsychologia 37 (1999) 159-167

ix Contribution

of noninvasive cortical stimulation to the study of memory functions A. Floela, L.G. Cohen Brain Research Reviews 53 (2007) 250–259

x Stimulating

language: insights from TMS Joseph T. Devlin and Kate E. Watkins Brain 130, (2007) 610–622

xi Applications

of TMS to Therapy in Psychiatry.

Lisanby, Sarah H.; Kinnunen, Leann H.; Crupain, Michael J. Journal of Clinical Neurophysiology. 19(4):344-360, August 2002.

xii Exploring Theta

Burst Stimulation as an intervention to improve motor recovery in chronic stroke P. Talelli, R. Greenwood, J. Rothwell Clinical Neurophysiology, Volume 118, Issue 2, Pages 333-342

Users of Magstim Transcranial Magnetic Stimulators in the USA please note: Caution - Investigational Device. Federal (or United States law) limits device to investigational use.

All standard products carry the mark, comply with the Medical Device Directive 93/42/EEC, and are manufactured under a Quality System certified to ISO 13485. © 2010 The Magstim Company Limited. Magstim®, and Air FilmTM are registered trademarks of The Magstim Company Limited.

All specifications are subject to change. All material in this literature is produced in good faith

This brochure is intended for users outside the USA